Tong Xin, Xue Xindong, Fu Jianhua
Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China. Email:
Zhonghua Er Ke Za Zhi. 2014 Apr;52(4):277-81.
To observe the dynamic changes of MRI in the preterm infants with punctate white matter damage (PWMD), and to explore the clinical significance of apparent diffusion coefficient (ADC) values by continuously measuring the lesions and surrounding region by applying diffusion weighted imaging (DWI).
MRI, using conventional and diffusion weighted imaging, was performed in 151 preterm infants within 7 days after birth between October 2010 to June 2011 in NICU. Twenty-four preterm infants with PWMD and 24 controls were obtained according to their MRI results. The control group infants were those with normal MRI results and at the same gestational age as those with PWMDs. The ADC value was measured for the lesions and their surrounding regions, and for the same sites of the controls. All the PWMD were followed up for 2-5 weeks, and apparent diffusion coefficients were measured at the same regions. The variation of magnetic resonance imaging was observed and the apparent diffusion coefficients were compared.
The first MRI scanning: in the 24 cases with PWMD, high signals on DWI were seen in all patients (100%), increased signal intensity on T1-weighted images were seen in 19 (79.2%) patients, increased signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images were seen in 4 (16.6%) patients. The second MRI scanning: in the 24 cases with PWMD, The high signal on DWI vanished in all patients (100%), the increased signal intensity on T1-weighted images vanished in 9 (39.1%) patients, the increased signal intensity on T1-weighted images did not vanish but was smaller than before in 14 (60.9%) patients. The measurement of ADC values: the mean ADC value of the lesions in the group of PWMD was (942 ± 170)×10(-3)mm(2)/s, significantly lower than the area surrounding (1 554 ± 116)×10(-3)mm(2)/s and the same area of the control group (1 524 ± 116)×10(-3)mm(2)/s ( P < 0.05). The second MRI scanning: the mean ADC of the lesions in the PWMD group was up to (1 468 ± 195)×10(-3)mm(2)/s, which is significantly higher than before, but still lower than the areas surrounding the lesion (1 586 ± 97)×10(-3)mm(2)/s (P < 0.05).
Continuous measurement of ADC values in the lesions and surrounding areas is important to describe the micro-change of PWMD.
观察早产儿点状白质损伤（PWMD）的MRI动态变化，通过应用扩散加权成像（DWI）连续测量病变及其周围区域，探讨表观扩散系数（ADC）值的临床意义。
2010年10月至2011年6月在新生儿重症监护病房（NICU）对151例出生后7天内的早产儿进行常规及扩散加权成像MRI检查。根据MRI结果选取24例PWMD早产儿及24例对照婴儿。对照组婴儿MRI结果正常且与PWMD婴儿孕周相同。测量病变及其周围区域以及对照组相同部位的ADC值。对所有PWMD婴儿随访2 - 5周，在相同区域测量表观扩散系数。观察磁共振成像的变化并比较表观扩散系数。
首次MRI扫描：24例PWMD患者中，所有患者（100%）DWI上均见高信号，19例（79.2%）患者T1加权像信号强度增加，4例（16.6%）患者T1加权像信号强度增加且T2加权像信号强度降低。第二次MRI扫描：24例PWMD患者中，所有患者（100%）DWI上高信号消失，9例（39.1%）患者T1加权像上增加的信号强度消失，14例（60.9%）患者T1加权像上增加的信号强度未消失但较之前减小。ADC值测量：PWMD组病变的平均ADC值为（942±170）×10⁻³mm²/s，显著低于周围区域（1554±116）×⁻³mm²/s及对照组相同区域（1524±116）×10⁻³mm²/s（P<0.05）。第二次MRI扫描：PWMD组病变的平均ADC值高达（1468±195）×10⁻³mm²/s，显著高于之前，但仍低于病变周围区域（1586±97）×10⁻³mm²/s（P<0.05）。
连续测量病变及其周围区域的ADC值对于描述PWMD的微观变化很重要。
